| NPI | 1134107246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7435) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 12028) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2011-02-08 |